Healthcare Provider Details

I. General information

NPI: 1477365690
Provider Name (Legal Business Name): MARIA GUADALUPE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N FRESNO ST STE 106
FRESNO CA
93710-6849
US

IV. Provider business mailing address

1329 N LESLIE ST
VISALIA CA
93291-3239
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax: 866-500-2186
Mailing address:
  • Phone: 559-679-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: